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Franciscan Health System • The South Sound’s Leader in Heart Care

Recipes & Tips

Heart-Healthy For the Living whole family! ‘Must haves’ for your pantry Doctors’ advice to use today Franciscan Health System • 2013


Life and Good Health are Precious Gifts. At Franciscan, we want to help you live well to preserve yours. While heart disease is the leading cause of death in our country, it doesn’t have to be. Most heart problems can be prevented – some even reversed – through fairly simple changes in lifestyle. So we challenge you to take charge of your heart health. And we promise to walk with you every step of the way. Throughout the South Sound, Franciscan Heart Center is everywhere you find Franciscan. It’s our caring family doctors attentive to your heart health, our community education programs to help you live your best life, and our exceptional team of cardiologists, heart and vascular surgeons and other dedicated specialists focused on one goal: getting you back to the life you love. Here’s to your heart health! Franciscan Heart Center.

It’s Time for a Heart to Heart. Make the most of your wellness exam by making a list before your appointment. Things you want to cover include:

Prevention • What tests are recommended for someone my age? • What is the purpose of each? • How often should they be repeated?

Symptoms and concerns • Pain. Type, location, frequency and duration. • Health challenges. Be specific. If you have trouble sleeping, how often? Falling asleep, staying asleep, or both? Do you have other symptoms, like night sweats or daytime sleepiness? The more information you share, the more complete picture you provide your doctor.

“I appreciate it when my patients bring questions and topics for discussion. I want them to be engaged in our partnership for their health.” Janis Fegley, DO, family medicine; division chief of primary care

Treatment recommendations Get news and information about heart health events and more at: www.facebook.com/ FranciscanHealth www.twitter.com/FHShealth www.youtube.com (Search for Franciscan Health System)

• What are my options? • Are there side effects? • What are the consequences if I don’t follow through? • Which option would you choose, and why? Don’t have a family physician? We can help you find a provider to help keep you and your heart healthy! Call 1 (888) 825-3227 or visit www.FranciscanDoctors.org today.

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Good Advice from Our Experts Don’t Worry; Take Action! We know a lot about what causes heart disease and the steps we can take to prevent it. Best of all, it’s never too late to protect your heart! • Don’t smoke. “The time to start worrying about your heart is...never! Worry is passive and stressful. Instead, take positive action steps to maintain and improve your heart health.” William Bilnoski, MD, medical director, cardiology

• Eat a diet stingy in fats and rich in fiber, fruits and veggies. • Eliminate hidden sugars (hint: they often end in “ose” - sucrose, glucose, fructose, maltrose and dextrose; corn syrups) • Get moving – exercise at least 30 minutes a day, 5 days a week, every week.

Arteries carry oxygen-rich blood to the organs. Veins carry blood back to the heart. While varicose veins may be unsightly, they can be easily corrected. It’s the arteries that can cause real problems. Clogged arteries outside the heart cause peripheral arterial disease (PAD), which often goes undetected. Abdominal aortic aneurysm (AAA), a bulging, weak area in the artery that supplies blood to the abdomen, pelvis and legs, is another silent threat. See your doctor if you experience: • Painful cramping, numbness or tingling in your legs, feet or buttocks • Pain or tingling in your leg when you walk, which goes away when you stop • Poor wound healing or changes to the color of the legs and feet

“Don’t attribute leg pain to aging or inactivity. It is a sign that your muscles aren’t getting enough oxygen. See your doctor! If you have plaque in your leg arteries, chances are plaque is in the arteries of your heart and brain, too.” Todd Kihara, MD, medical director, Franciscan Vascular Labs

Women: Heart discrimination ahead. • Heart disease kills more women than men each year; and kills more women than all types of cancer combined. • Metabolic syndrome (abdominal fat, high blood pressure/blood sugar/ triglycerides) more negatively affects women’s hearts. • A woman’s risk for coronary artery disease increases after menopause. • Heart attack symptoms can be subtle or vague, so women are more likely to delay seeking help. Don’t wait! Call 9-1-1.

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Stay in Circulation

Did you know? Medicare covers a one-time abdominal aortic aneurysm (AAA) screening ultrasound (provided at all Franciscan hospitals) if you get an at-risk referral as a result of your “Welcome to Medicare” physical exam. Ask your doctor about it.

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Facing Heart Surgery?

Craig Hampton, MD, FACS cardiothoracic surgery

Cardiovascular diseases involving the heart and blood vessel system include heart disease, stroke, high blood pressure, and angina (chest pain). Risk factors you cannot control • Increasing age (male over 45; female over 55) • Gender (more men have heart attacks earlier in life, but heart disease will kill more women) • Family history

Life after a heart event Experiencing a heart event is life-altering. Talk to your doctor about valuable follow-up care. You may feel nervous about doing what is required to strengthen your heart – and recover your quality of life. It’s important to know you’re not alone. We have the resources you need to get your health, and your confidence, back on track! Cardiac Rehabilitation Specially trained nurses and exercise physiologists provide your “exercise prescription” and monitor your progress. You can exercise safely, with less worry. Heart Failure Clinic You can successfully live with heart failure, as long as it is medically managed. Our Heart Failure clinic staff works closely with you and your doctor to: • Treat symptoms (such as fluid retention and fatigue) • Better manage medications • Improve your quality of life — and keep you out of the hospital.

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Cardiovascular diseases: Are you at risk?

Risk factors you can control • Quit smoking • Exercise regularly • Limit alcohol • Control your blood pressure • Manage your cholesterol • Ease stress • Prevent or manage diabetes © 2013, Health Marketing Solutions, Inc. | wellfedheart.com

“Today’s minimally invasive techniques treat many heart problems, including valve repair and replacement. For our patients, this means less pain and faster recoveries.”

Risk Factors

At Franciscan, we know the thought of surgery — especially heart surgery — is enough to make your heart skip a beat. Rest assured; Franciscan’s surgical outcomes are among the best in the nation. St. Joseph Medical Center was awarded a 3-star rating for 2011 for heart bypass surgery. Only 15 percent of cardiothoracic surgery practices in the country earn this distinction given by the Society of Thoracic Surgeons.

Snooze to lose Obesity is three times more common in people who get fewer than seven hours of sleep per night. Poor sleep is also associated with diabetes, high blood pressure, and heart disease.

You can cut your risk of heart attack and stroke in half by adopting healthy changes. Call your healthcare provider to discuss priorities and make a plan.

Commit to getting seven or more hours of sleep per night.

Slee p on it.

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Cardiovascular Diseases: Know the Signs Your risk: what to know & do

9-1-1 Heart Attack?

Call 9-1-1 with any of these symptoms: • Chest pain or upper body discomfort • Shortness of breath • Cold sweats, nausea, or lightheadedness • Racing heart beat

Stroke?

Call 9-1-1 if you suspect someone is having a stroke, and can’t: • Smile • Raise both arms • Repeat a simple sentence

Coronary Heart Disease • Also known simply as heart disease, CHD is one of several cardiovascular diseases of the heart and blood vessel system. With symptoms that can be life threatening, CHD can lead to heart attack and heart failure. It is the leading cause of death for Americans. Vascular Disease • Clogged arteries and hardening of the arteries occur when blood vessels become damaged from high blood pressure, cholesterol, or other fatty buildup. The result—restricted blood flow— can cause tissue damage, stroke, or death. Stroke • Often called a brain attack, stroke occurs when a blood vessel in the brain bursts or is blocked, interrupting blood flow to the brain. • Signs include numbness, confusion, trouble speaking, and severe headache.

Diabetes • People with diabetes have a three times higher risk of developing cardiovascular disease. • The same good habits that prevent heart disease can help prevent diabetes. Do! You can prevent or manage heart disease, stroke, high blood pressure, and diabetes by adopting these good-for-you habits: • If you smoke, stop. • Exercise 30 to 60 minutes most days. • Adopt principles of the Mediterranean lifestyle as explained in this booklet. • Maintain a healthy weight. • Get regular checkups. • Eat at home.

High Blood Pressure • Also known as hypertension, it weakens and damages the arteries, which can lead to heart disease and stroke. • It’s called the “silent killer” because people often show no symptoms. Cholesterol • LDL (think L for lousy) is bad cholesterol, raising your risk of heart and vascular diseases, and stroke.

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• HDL is good cholesterol (H for healthy). High levels can lower your risk of heart disease.

and commit to three changes you can make and sustain. PICK ONE ACTION FROM THE LIST

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What’s your number?

Vital Digits

Healthy

At Risk

High Risk

Total Cholesterol

Less than 200

201 – 239

240 and above

LDL (Lousy) Cholesterol

Less than 100

101 – 159

160 and above

HDL (Healthy) Cholesterol

60 or higher

51 – 59 Women

50 or less

41 – 59 Men

40 or less

Triglycerides

Less than 150

151 – 199

200 and above

Fasting Blood Sugar

Less than 100

101 – 125

126 and above

CRP (measures inflammation)

Less than 1.0

1.0 – 2 .9

3.0 or higher

Systolic

Less than 120

121 – 139

140 or higher

Diastolic

Less than 80

81 – 89

90 or higher

Date

Date

Date

Date

Blood Pressure

Weight Waist Circumference Women

Less than 35"

35" or greater

Men

Less than 40"

40" or greater

Body Mass Index (BMI)

19 – 24

Apple or pear? Body shape matters Higher risk

Lower risk

People with apple-shaped bodies—larger waists with extra weight around the abdomen—are at a higher risk of developing diabetes, heart disease, and other complications of metabolic syndrome. Those who have a narrow waist and carry more weight around the hips—pear-shaped—have a lower risk. Since we inherit our body shape, it’s one more reason to take control of the risk factors within our power to change.

Metabolic syndrome? Check yourself Symptoms of metabolic syndrome increase your risk for heart disease, stroke, and diabetes. This risk is greater if you are overweight or inactive. And it’s highest in Hispanic, Native American, and AfricanAmerican populations.

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25 – 29

30 or higher

If you have two or more of these conditions, consult your healthcare provider: • High blood pressure • Elevated fasting blood sugars • Extra weight, especially around the waist • Abnormal blood lipid (cholesterol) levels

USE THE CHART ABOVE TO TR ACK YOUR

Local health fairs or hospitals are a good resource for health screenings. Or contact your healthcare provider, who may further customize your screening schedule based on your personal and family medical history. NUM BE RS OVE R TIME .

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Heart-Healthy Plate

1/2 fruits and nonstarchy vegetables • Apples • Berries • Broccoli • Brussels sprouts • Cabbage • Carrots • Cauliflower • Cucumber • Green beans

• Melon • Onions • Tomatoes • Dark leafy greens • Eggplants • Peaches • Pears • Plums • Zucchini

1/4 lean protein

1/4 whole grains or starchy vegetables

• Lean beef, pork and fish • Dried beans, peas and lentils • Chicken and turkey breasts • Tofu, tempeh • Eggs • Nuts • Low-fat milk, yogurt and cheese

• Barley (non-pearled is best) • Brown rice, quinoa and oats • Dried beans, peas and lentils • Whole wheat pasta • Corn • Potatoes • Winter squash

Mediterranean: Not a diet, a lifestyle Live longer, and reduce your risk of heart disease, stroke, and diabetes by eating as our Mediterranean neighbors do: • More fruits, veggies, beans, nuts, seeds, and grains • Olive oil as your main fat source • Small daily servings of non- or low-fat cheese and yogurt • Two to three servings of baked or broiled fish weekly • Lean red meat only once or twice a month If lower blood pressure is your goal, consider the low-sodium DASH diet; see the National Heart, Lung and Blood Institute website.

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Need help with se rving sizes?

Use a food scale or try these visual cues for a single serving of: Lean protein

Cheese

Pasta, rice, beans

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The other side of the story

Food Labels: Front and Back

What’s really inside today’s packaged and processed foods—and beverages—is revealed on the Nutrition Facts label. This tell-all most often appears on the product’s back side. It is intended to help you make informed choices.

Buzz words decoded

Verify what’s inside: Read the ingredients listed on the back of the package. The first thing listed is what weighs the most in the total weight of the food item. If you see the healthiest ingredients are toward the end of the list, they’re probably not a significant source of nutrition.

Today’s packaged foods entice us with marketing words that are often misleading. Here are some of the popular ones:

Is this serving size reasonable?

Check calories

• Natural. The food product may still contain pesticides, genetically modified ingredients, high-fructose corn syrup, and be heavily processed. • Healthy. While the food must meet specific guidelines for fat, cholesterol, sodium, and certain nutrients, it can still contain large amounts of sugar, preservatives, and artificial ingredients. • Lightly sweetened. This term is not regulated by the FDA, so the product could contain any amount of sugar. • Made with whole grains. Be sure “whole grain” or “whole-wheat flour” is among the first three or four ingredients listed on the package.

Limit these nutrients

5% or less is low 20% or more is high Aim daily for less than 300 mg of cholesterol

Get enough of these nutrients

• Reduced sugar. The FDA controls this, and it means that the product contains 25% less sugar than the regular product. • Sugar-free. The FDA states that the product cannot contain more than .5 grams of sugar or 1/8 teaspoon per serving.

Don't forget to look for the expiration date.

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Start here

Know what you ’re buying an d e ating

by reading food labels. Before buying a packaged food item, answer the question, “Is the nutrition in this good for me?” 13


Golden rules of food

Culprits: Fats, Sugar, Sodium What lurks in your pantry?

Buyer beware! Packaged foods often contain large amounts of sodium from preservatives and additives, while packaged low-fat foods commonly get a flavor boost from sugar. Read the labels.

Not all teaspoons of salt are the same • Most people will get more sodium than they require daily without adding any salt to their food.

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Fat free. Naturally sweetened. All natural. Don’t be fooled by misleading language on labels; look for the hidden or added sugar, salt, and fat. Consider these heart-healthy guidelines: • Reduce your intake of solid fats (saturated and trans fats), replacing them with poly- and monounsaturated oils. Less than 35 percent of your total daily calories should come from fat. • Watch the sugar: 4 grams equal 1 teaspoon. Most of us should have no more than 5 to 9 teaspoons per day. • Your overall daily diet should contain no more than 2,300 mg of sodium. Sodium is the part of salt that is most pertinent to your health. African-Americans, adults 50+, and all ages with hypertension, diabetes, or chronic kidney disease should limit their daily sodium intake to 1,500 mg.

Table

2,300mg sodium

fine grain

Kosher

1,760mg sodium

course grain

Sea

1,570mg sodium

flakey

1. Build from breakfast. Break your nightly fast with a healthy breakfast. 2. Eat the rainbow. Yellow peppers, red beets, purple cabbage. 3. Eat an apple a day. And keep going. Fruits and vegetables lower your risk of high blood pressure, heart disease, and stroke. 4. Turn over a new leaf. Make dark leafy greens, such as kale, spinach, and Swiss chard, a frequent vegetable choice. 5. Learn to love legumes. Good options are beans, lentils, peas, soybeans, and peanuts—all high in fiber, protein, iron and B vitamins. 6. Get hooked on fish. Meatless Monday, Tuna Tuesday, Sardine Saturday, Salmon Sunday. You get the idea: less meat and more fish with heart-protecting omega-3’s. 7. Correct your carbs. Pass on processed snacks, such as chips and crackers. Remember that healthy carbs are found in all plant foods and are essential fuel for your body and brain. 8. Keep grains whole. Three daily servings of whole or minimally processed grains, such as brown rice, quinoa, and bulgur, will reduce your risk of cardiovascular disease, diabetes, and obesity.

With p ortion sizes eve r in cre asing —

at convenience stores, restaurants, and in movie theaters—we inadvertently consume more calories than we need. Know common portion sizes. When given a choice, order the smallest size.

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The Well-Fed Heart

Budget shopping = Better eating • Purchase frozen fruits and vegetables in the off-season. Save fresh purchases for in-season, locally grown produce when they’re less expensive. • Buy in bulk nuts, grains, pasta and other foods. • Menu planning saves time and money. Work leftovers into your menus. • Store brands are often cheaper than using coupons. • Coupons may save money, but they often are for highly processed foods. Check labels. • Stock up on canned goods when often-used items are on sale. • Get your omega-3’s economically from canned salmon, sardines and herring. • Serve lean protein as a side dish the size of a deck of cards, rather than the main event. • Plan meals from your pantry or freezer once or twice a week. • For snacks on-the-go, packing your own saves money.

How healthy is your kitchen?

Stock

Toss

1. Oatmeal and whole-grain cereals with no more than 120 calories and at least 5 grams of fiber per serving

1. Toaster pastries and cereals with more than 5 grams of sugar per serving

2. 100 percent whole-wheat bread, whole-grain crackers, brown rice

2. White—bread, crackers, rice

3. Canned low-sodium tomatoes and beans

3. Canned goods with added sugar, salt and fats

4. Unsalted nuts, plant-based oils, 4. Trans-fat-laden snacks packaged snacks with zero (chips, buttery crackers); trans fats solid shortening 5. Low-fat or nonfat dairy products

5. Full-fat dairy products

6. Whole-wheat pasta, bulgur, quinoa, barley

6. White pasta and boxed macaroni and cheese

7. Healthier frozen dinners with whole grains, veggies

7. High-fat and salty frozen dinners

8. Peanut, almond, or cashew butters containing only nuts; low-sugar fruit spreads

8. Peanut butter and jams with added sugar

9. Dried fruits, such as raisins, apricots, mangos

9. Gummy fruit snacks with artificial flavors; canned fruits with added sugar

10. Milk, plain ice tea, coffee, water

10. Sugary drinks

Savvy gro ce ry sho ppe rs save m oney

by always going with a list (and never shopping hungry). Commit to adding heart friendly foods to your grocery list and checking labels when in doubt. 16

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Meal Planning Saves Time and Money Here’s a common complaint: Eating healthy at home takes too much time.

Our answer: In just 15-20 minutes of planning every week or two, you’ll be organized for the next batch of meals. In many of our recipes, note how you can count on leftovers or purchase more of one food for another meal. There are many cook-ahead options, too. You can add or subtract ingredients to many of these recipes for dietary preferences.

Sample Meal Planner Day Sunday Dinner

Monday Lunch Dinner

Meal Planning Tips 1. Incorporate just a few new recipes each week, mixing our recipes with yours. Use what’s already in your freezer and pantry, too. 2. There’s nothing worse than leftovers going bad. So, there’s a space for lunch (M-F) as a reminder to pack leftovers in reusable containers for lunch the next day or for a fast dinner. 3. By doing this for 3-4 weeks, all you’ll have to do is rotate your menu plans on a monthly or seasonal basis. For more heart-healthy recipe ideas, go to wellfedheart.com

Tuesday Lunch Dinner

Wednesday Lunch Dinner

Meal

Notes

Hearty Chicken Harvest Dinner

2 guests

Chicken leftovers Creamy Portobello Burgers w/Green Gusto Salad

pick up buns!

Portobello burgers w/ pickles Family Night Fish Tacos

soccer practice

taco salad soup from freezer

working late

and find 2-4 that you’d like to incorporate into your menu plan. Check the Kitchen Basics and the Fresh Ingredients lists to plan what you’ll need at the grocery store. By sticking to a list, you’ll save time in the aisles and money at checkout, too. Go ahead…try it, now!

Re ad the recipes in this booklet

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Make Mondays Meatless

Sweet Barley Pilaf and Green Gusto Salad Serves 6

Creamy Portobello Burgers Serves 4

1 tablespoon olive oil 4 portobello mushrooms, stems removed and chopped 1 large onion, halved and cut in ¼-inch strips 1 large yellow or red bell pepper, deseeded and cut into ¼-inch strips 1 teaspoon each of thyme and sage 4 ounces soft goat cheese, divided Optional: lettuce and tomato, whole wheat buns

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1 Turn on broiler, set to high

5 Spread goat cheese in

or 500°.

each cap and broil for 2 more minutes. Top with cooked vegetables and optional serving ideas as shown here.

2 Heat olive oil in large sauté pan over medium heat.

3 Sauté chopped mushroom stems, onions, peppers and herbs until onions are translucent.

4 On a cookie sheet, broil mushrooms stem side down for 2-3 minutes. Turn over and broil stem side up for 3-4 minutes until liquid starts to accumulate in cap of mushroom.

Per serving: 157 calories, 8g protein, 11g carbohydrate, 10g fat, 5g sat fat, 4g mono fat, 13mg cholesterol, 3g fiber, 112mg sodium Per serving with bun: 271 calories, 12g protein, 33g carbohydrate, 12g fat, 5g sat fat, 4g mono fat, 13mg cholesterol, 6g fiber, 318mg sodium

1 tablespoon olive oil 1 large onion, minced 1 cup mushrooms, sliced 1 celery stalk, chopped ½ cup slivered almonds 1 cup barley or other whole grain ¼ cup raisins, golden or black dash of salt 1 tablespoon each fresh rosemary and marjoram, minced or ½ teaspoon dried 3 cups chicken or vegetable broth, low-sodium

1 In large saucepan, heat olive oil and sauté onion until translucent. Add mushrooms, celery and almonds. Cook 3-5 minutes.

2 Stir in barley, raisins and seasonings until barley is coated with other ingredients.

3 Add chicken broth and bring to a boil for 2 minutes, reduce to simmer for 55 minutes.

Per serving: 254 calories, 10g protein, 35g carbohydrate, 10g fat, 1g sat fat, 6g mono fat, 0mg cholesterol, 8g fiber, 80mg sodium

1 pound green beans, ends trimmed and sliced into 1-inch lengths 2 cups frozen peas 2 scallions, chopped 1 orange or canned mandarins pepper to taste Dressing ²/³ cup plain nonfat yogurt 2 tablespoons fresh mint, chopped 2 tablespoons orange peel, finely grated

1 In a bowl, mix the orange peel with yogurt and fresh mint. Set aside.

2 Boil green beans for 3 minutes. They should be a bit crunchy. Run under cold water to stop the cooking process, drain and put in a bowl.

3 Defrost peas under cool running water. Drain and add to beans with scallions and pepper to taste. Mix and refrigerate for 10 minutes.

4 Peel the remaining orange skin and fibers and cut into bite-size pieces.

5 Just before serving, add dressing to salad and toss. Plate and garnish with orange sections.

Per serving: 92 calories, 6g protein, 18g carbohydrate, 0g fat, 0g sat fat, 0g mono fat, 0mg cholesterol, 5g fiber, 75mg sodium

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Love Your Omega-3’s

Warm Gazpacho with Sizzling Fish

Family Night Fish Tacos

Serves 6

4 large tomatoes, quartered, deseeded and chopped (approx 3 cups) 1 large cucumber, peeled, deseeded and chopped 1 medium onion, chopped (approx 1 cup) 1 red bell pepper, chopped 1 garlic clove, minced 2 tablespoons chopped fresh herbs such as basil, thyme, oregano or parsley ¼ teaspoon smoked paprika ¼ teaspoon black pepper 2 cups canned low-sodium tomato juice 2 tablespoons olive oil 1½ pounds cod or other thick, firm white fish, cut in 6 equal portions Optional garnish: chopped scallions

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1 Add first 8 ingredients in

Serves 6

food processor and puree until well-mixed but still coarsely textured.

2 Add tomato juice and pulse once or twice to blend.

3 Warm finished gazpacho to serving temperature but DO NOT BOIL.

4 Heat olive oil in large skillet over medium heat until just starting to smoke. Sauté fish 2 minutes per side or until lightly browned. Ladle soup into bowls and gently place fish on top so it looks like it is floating.

Seasoned Cook Make a double batch of gazpacho and freeze leftovers for another meal. Per serving: 198 calories, 22g protein, 14g carbohydrate, 4g fat, 1g sat fat, 1g mono fat, 47mg cholesterol, 3g fiber, 142mg sodium

½ pound cod or other firm white fish 1 teaspoon black pepper 1 tablespoon olive oil 1 red bell pepper, sliced 1 medium onion, sliced 4 cloves garlic, minced 1 tablespoon oregano 1 15-ounce can black beans, rinsed and drained 1 small can sliced black olives 1 tablespoon lime juice 6 whole wheat or corn 12-inch tortillas, warmed in low oven

1 Season fish with pepper. 2 Heat olive oil and sauté red pepper, onion, garlic and oregano. Place in a bowl.

3 Sauté fish until cooked through, then flake into small pieces.

4 Fold beans and olives into the fish and heat through. Add fish mixture to vegetables and sprinkle with lime juice.

5 To make a taco, place mixture in center of tortilla with condiments. Fold opposite sides in and roll.

Seasoned Cook Try condiments such as salsa, nonfat sour cream, shredded cabbage, diced tomatoes, sliced avocados and cilantro. Per serving: 179 calories, 14g protein, 22g carbohydrate, 5g fat, 0g sat fat, 3g mono fat, 14mg cholesterol, 7g fiber, 485mg sodium

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Get Your Super Greens

Asian Greens Ribbon Salad and Sweet Potato Shrimp Cakes Serves 4

Super Greens Pasta Bake Serves 8

12 ounces dry whole wheat pasta (fusilli or other)

1 Cook pasta according to

3 cups tomato sauce with onions and garlic (no salt added)

2 Preheat oven to 375°. 3 In a bowl, combine

2 cups sliced mushrooms 4 cups dark leafy greens like kale, spinach or Swiss chard 1½ cups shredded partskim mozzarella cheese Optional: 2 cups cooked, diced protein such as chicken or low-fat turkey sausage

package directions, drain.

tomato sauce, mushrooms and kale with the pasta and mix. Add optional chicken or sausage if using. Add pepper to taste.

4 Pour into oven-proof casserole dish. Top with cheese and bake 20-30 minutes, until heated through and cheese is bubbly. Per serving: 242 calories, 13g protein, 37g carbohydrate, 5g fat, 3g sat fat, 1g mono fat, 11mg cholesterol, 2g fiber, 130mg sodium

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Seasoned Cook Assemble this dish the night before. Taste tomato sauce before using — if needed, add seasonings. Red pepper flakes are a spicy addition. Fiber content of whole wheat pasta can vary by manufacturer— check the labels.

6 cups greens, like kale, Swiss chard, cabbage, spinach ¼ cup toasted sunflower seeds ¼ cup slivered almonds ¼ cup golden raisins Dressing 1 tablespoon canola oil ½ tablespoon each cider vinegar, honey, chopped mint ¼ teaspoon sesame oil

1 Slice the greens or cut with scissors into thin ribbons. Toss together in salad bowl.

2 Add sunflower seeds, almonds and raisins to greens.

3 Put dressing ingredients in a small jar and shake until blended. Drizzle over greens, toss and serve. Per serving: 200 calories, 6g protein, 22g carbohydrate, 12g fat, 2g sat fat, 6g mono fat, 0mg cholesterol, 4g fiber, 136mg sodium

¾ pound sweet potato, peeled and grated ½ pound small whole shrimp, peeled and diced 3 whole scallions, chopped 1 garlic clove, crushed 1 tablespoon fresh ginger, grated ½ teaspoon salt 3 tablespoons cornstarch 3 egg whites 2 tablespoons canola oil

1 Mix first 6 ingredients in a bowl.

2 Whisk egg whites and cornstarch in a separate bowl until frothy, then add to sweet potatoes. Mix thoroughly.

3 Form small patties of the mixture (about 2 tablespoons each) and place on a plate. Refrigerate 10 minutes.

4 Heat oil in a large nonstick skillet over medium-high heat. Transfer the patties to the skillet using a spatula. Cook 5 minutes per side. Drain on paper towel. Serve as shown or in lettuce leaf wraps. Per serving: 340 calories, 20g protein, 46g carbohydrates, 8g fat, 1g sat fat, 5g mono fat, 113mg cholesterol, 3g fiber, 478mg sodium

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Fortify With Fiber

Hearty Chicken Harvest Dinner Serves 4

Rainbow Lentil Medley Serves 4

2 cups broth, chicken or vegetable, low-sodium 1 cup water 1 cup lentils, rinsed 3-4 cloves garlic, minced ¼ teaspoon each black pepper and oregano 6 cups mixed vegetables, thinly sliced or diced, such as broccoli, squash, onion, red bell pepper, carrots 2 tablespoons fresh mint, finely chopped 2 ounces crumbled goat or blue cheese Dressing ¼ cup lemon juice 2 tablespoons olive oil 1 tablespoon Dijon mustard

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1 In a medium pot, bring broth and water to boil. Add lentils, garlic, black pepper and oregano. Reduce to simmer, cover and cook for 20 minutes. Drain any remaining liquid.

2 Meanwhile, in a steamer, cook vegetables until just tender.

3 Put lemon juice, oil and mustard in a small jar and shake until blended.

Seasoned Cook This dish adapts to whatever vegetables are in season and whatever grains or beans you have in your pantry.

4 Put all ingredients, except cheese, in a large bowl and toss.

5 Sprinkle cheese on top.

375 calories, 22g protein, 47g carbohydrates, 13g fat, 4g sat fat, 6g mono fat, 11mg cholesterol, 19g fiber, 212mg sodium

¾ pound chicken breasts, boneless, skinless 1 tablespoon olive oil Olive oil spray 1 medium onion, thinly sliced 2 bell peppers, yellow or red, sliced 1 garlic clove, minced 1 14-ounce can diced tomatoes, low-sodium ²/³ cup chicken stock, low-sodium 1 tablespoon each oregano, basil 1 cup canned cannellini beans, rinsed and drained

1 Over medium heat, sauté the chicken in olive oil until golden brown. Remove from pan.

2 Spray pan with olive oil, add onion, peppers, garlic and sauté until onions are translucent, 3-5 minutes.

3 Add tomatoes with juice and stir. Place the chicken over mixture, add stock and sprinkle with herbs.

4 Cover the pan and simmer for 30 minutes, stirring occasionally. To test when chicken is done, poke a knife in meat and juices should run clear.

5 Mash half of the beans, then add to pot and stir into liquid until sauce thickens. Add the rest of beans and simmer for 5 minutes more. Serve in bowls with green salad and crusty bread.

Seasoned Cook This is a perfect makeahead dinner. Consider doubling the recipe—it makes great leftovers. Per serving: 324 calories, 28g protein, 29g carbohydrate, 8g fat, 2g sat fat, 4g mono fat, 78mg cholesterol, 6g fiber, 293mg sodium

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No-Bake Entertaining

Herbaceous Garbanzo Bean and Tomato Salad Serves 4

1 cup mixed fresh herbs like basil, mint, cilantro, finely chopped 2 cups garbanzo beans (chickpeas), drained 2 cups cherry tomatoes, halved 6 black olives, pitted and sliced lengthwise 3 scallions, sliced Optional: canned fish Dressing 2 tablespoons red wine vinegar 2 tablespoons olive oil ½ teaspoon honey

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1 Place all ingredients in a salad bowl and mix thoroughly.

2 Make the dressing in a small glass jar and shake.

3 Pour dressing on salad, toss and serve. Per serving: 249 calories, 9g protein, 32g carbohydrates, 10g fat, 1g sat fat, 6g mono fat, 0mg cholesterol, 8g fiber, 120mg sodium

Seasoned Cook You’ll love the brightness in flavors and versatility of this dish. It can stand alone, be served casually with canned fish or grilled lean protein.

No-Bake Berry Date Deluxe Serves 8

3 cups dates, pitted and roughly chopped ¼ cup rolled oats ½ cup slivered almonds 1 cup berries, such as strawberries, raspberries or blueberries, mashed 1 cup fresh berries

1 Put almonds in food processor and pulse until finely chopped.

2 Add dates and oats and pulse until dates are finely chopped.

3 Press mixture into an 8-inch baking dish, preferably with removable sides. Top with mashed berries. Cover and set aside at least 30 minutes.

4 Before serving, top with fresh berries. Per serving: 235 calories, 4g protein, 49g carbohydrate, 5g fat, 0g sat fat, 3g mono fat, 0mg cholesterol, 7g fiber, 31mg sodium

Seasoned Cook You can make this dessert through Step 3 and refrigerate overnight to give the berries a chance to meld into the crust. To save money, use frozen fruit for the mash.

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Heart-Healthy Kitchen Basics

Fresh Ingredients

Starting with the ingredients below, add and subtract to create your own heart-healthy Kitchen Basics. Having a well-stocked kitchen makes shopping easier, because all you’ll need are a few fresh ingredients.

Read each recipe and check to make sure you have the basic ingredients in stock. This list will tell you what fresh items you’ll need.

In the Pantry Grains Barley* Brown rice Bulgur Rolled oats* Polenta Quinoa Whole wheat bread, pita Whole wheat pasta (spiral noodles*, other shapes) Whole wheat/rice crackers _________________ _________________ _________________ Beans/Peas (canned and dry) Black* White (cannellini, navy)* Garbanzo (chickpeas)* Lentils (brown*, red, black) Split peas _________________ _________________ _________________ Nuts & Seeds (unsalted), Dried Fruit Almonds, slivered* and whole Flaxseeds Sunflower seeds*

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Walnuts Golden raisins* (apricots, other) _________________ _________________ _________________ Canned Goods Broth, low-sodium chicken*, vegetable* Tomato juice, low-sodium* Tomatoes, diced, low-sodium* Tomato* or pasta sauce (no salt added) Black olives* Fish (salmon, tuna, herring) Salsa* _________________ _________________ _________________ Vinegars Cider* Red wine* White wine Balsamic _______________ _________________ _________________ Oils Olive oil* Olive oil spray* Canola oil* Sesame oil* _________________ _________________ _________________

Seasonings Basil*, Bay leaf, Black pepper*, Cayenne, Chili powder, Cinnamon, Cumin, Curry powder, Dill, Marjoram*, Oregano*, Red pepper flakes, Rosemary*, Sage* Salt* (kosher or sea), Smoked paprika*, Thyme*, Turmeric _________________ _________________ _________________ Other Staples Honey* Soy sauce, lowsodium Hot pepper sauce Ketchup Maple syrup Mustard: Dijon*, whole grain, Baking soda Baking powder Cornstarch* Flour, whole wheat and allpurpose Sugar (brown, white) Vanilla _________________ _________________ _________________

Eggs* Parmesan cheese Milk, nonfat Yogurt, nonfat* Butter, unsalted Lemon and lime juices* Lean protein _________________ _________________ _________________

In the Freezer Edamame Green beans Mixed vegetables Peas* Berries* Homemade broth Lean protein _________________ _________________ _________________

Produce Basics

p. 20

4 ounces goat cheese 4 portobello mushrooms 1 yellow or red bell pepper (optional) lettuce, tomatoes, whole wheat buns

p. 24

Barley Pilaf

Green Gusto Salad

p. 21

1 pound green beans 1 orange (or canned mandarins) scallions yogurt, plain

p. 25

1 ½ pounds cod 1 cucumber 1 red bell pepper 4 tomatoes (optional) scallions

p. 26

p. 23

p. 27

p. 25

¾ pound boneless, skinless chicken breasts 2 bell peppers, red or yellow

Herbaceous Garbanzo Bean and Tomato Salad p. 28

Asian Greens Ribbon Salad 6 cups dark leafy greens fresh mint scallions

6 cups mixed vegetables (broccoli, squash, red bell pepper, carrots) 2 ounces goat cheese mint

Hearty Chicken Harvest Dinner

Family Night Fish Tacos ½ pound cod 1 avocado 1 bunch cilantro ½ cabbage 1 red bell pepper 1 tomato nonfat sour cream 6 12-inch whole wheat or corn tortillas

½ pound small whole shrimp (bay or Oregon) ¾ pound sweet potato scallions ginger

Rainbow Lentil Medley

Warm Gazpacho with Sizzling Fish p. 22

4 cups dark leafy greens 2 cups mushrooms, sliced 1 ½ cups shredded part-skim mozzarella cheese (optional) 2 cups diced protein (chicken, turkey sausage)

Sweet Potato Shrimp Cakes

1 stalk celery 1 cup mushrooms, sliced

Onions* Garlic* Seasonal fruit Seasonal vegetables _________________ _________________ _________________ *Item used in the recipes in this booklet

Super Greens Pasta Bake

Creamy Portobello Burgers

In the Fridge

1 cup mixed fresh herbs (basil, mint, cilantro) 2 cups cherry tomatoes scallions (optional) flank steak, chicken

No-Bake Berry Date Deluxe p. 29

2 cups berries (strawberries, raspberries, blueberries) 3 cups pitted dates

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Make snacks fun!

Family Health

Whether it’s after school or before soccer practice, growing bodies are hungry ones that call for quick healthy snack choices rather than empty calories. Get rid of the junk food and sugary drinks. Instead, fill the pantry and fridge at eye level with the fixings for these fun and kid-friendly alternatives:

Make healthy living child’s play Healthy habits should be a family affair and with good reason. Children learn what they live. These five approaches will help them live well:

Play defense against diabetes Children and teenagers are being diagnosed with Type 2 diabetes at increasing rates. Diagnosed at young ages, they’re at greater risk for developing heart disease. So feed them a healthy diet and keep them active.

1. Play together. Find time for family games, swimming, or after-dinner walks. Children six and older need at least an hour a day of physical activity, and adults need at least 150 minutes per week. 2. Replace screen time with activity. Do your kids a favor: limit all screen time (TV, computer, video games) to less than two hours per day and none in the hour before bed. Keep video games active to get kids moving. 3. Follow their lead. Organized sports are a great way to stay fit, but they aren’t the only options. Let your child’s interests guide you—hike to collect leaves for an art project; head to a playground; or walk to the library. 4. Stamp out smoking. We know that the children of smokers are nearly twice as likely to become smokers themselves. Give yourself and your children a gift—quit now. 5. Drive by the drive-thru. Happy Meals aren’t healthy meals. If fast food is a must, forego the fries, and opt for milk rather than soda.

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• Frozen berries and yogurt

• Crisp apple wedges

• Celery sticks with peanut butter

• Sliced peaches

• Frozen red and green grapes

• Kiwi cups

• A handful of nuts and dried fruit

• Hard boiled eggs

• Veggie sticks

Have a family meeting

to map out everyone’s role in healthy living. Discuss menu planning and exercise options. When everyone plays a part, everybody wins. 33


Fire up your metabolism

Physical Activity Move it: so many reasons why Once you know the inside-and-out benefits of exercise—physical and mental gains!—you’ll lace up your tennies and get to it. Which of these will be your life changer? • Boost immune system • Maintain a healthy weight • Improve mental health • Sleep better • Develop new brain cells • Ease chronic back pain • Increase flexibility and endurance • Prevent osteoporosis • Prevent cardiovascular disease • Lower cholesterol • Promote better blood pressure • Reduce stroke risk • Live longer

How fast your body burns calories depends on genetics, gender (men burn more calories than women), and age (it slows steadily after 40). But fear not, there are ways to jump start your metabolism, helping your body to burn calories faster.

• Boost your cardio! Physical activity— especially high-intensity aerobic exercise—is one of the best ways to kindle your metabolism. • Muscle up. The more muscle and less fat you have, the more calories you burn. • Water, water everywhere. Getting dehydrated—even mildly—slows your metabolism. Drink water before eating and throughout the day. Beverages on ice help the body burn more calories. • Eat! Eating fewer than 1,200 calories per day makes it more difficult for your body to burn calories. Having a small meal or snack every three to four hours actually burns more calories. • Protein power. More calories are burned digesting protein than fat or carbs. Aim for lean meats, tofu, beans, eggs, and low-fat dairy products.

Strength training: It’s worth the weight A vital part of any fitness effort, strength training can reduce body fat, increase lean muscle, and burn calories more efficiently. Resistance moves build endurance, strength and balance, using your own body weight, free weights, stretchable bands, or weight machines. Gym memberships aren’t necessary. At home, canned goods can serve as free weights. Push-ups, abdominal crunches, and leg squats are great resistance exercises.

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Be accountable for your e xe rcise pl an .

Today start keeping a journal, so you’ll have a permanent record of your progress and your goals. 35


Making big changes can be daunting, but little ones don’t have to be. Consider doing one small thing per week to boost your heart health. 1. Get seven or more hours of sleep each night. 2. Keep up with regular health screenings. 3. Eat more fresh, unprocessed foods. 4. Learn how to read the Nutrition Facts on food and beverage products. 5. Shop with a food list; make sure heart-friendly foods are on it. 6. Involve all family members in menu planning and exercise. 7. Keep an exercise journal— with goals—so you can track your progress.

The Big Picture • Be a good role model: Don't just talk the talk—walk the walk. • Break a sweat: You don’t have to be an athlete, but get off the couch. • Clean up your kitchen: Fill your pantry with foods that nourish.

Nothing Escapes the Heart.

Small Changes, Big Gains

Many seemingly unrelated conditions affect heart health, too. Here are just a few of them: • Diabetes This disease ratchets up your risk for heart disease three-fold. If you have diabetes, manage it carefully with your doctor. If you’re pre-diabetic, lose excess weight and adopt a healthy lifestyle to reduce your risk. • Obesity Excessive weight causes blood lipid levels to rise, which in turn raises triglycerides and “bad” LDL cholesterol, and lowers “good” HLD cholesterol; all of which speeds up plaque buildup in your arteries. Take heart: even losing as little as 10 pounds can help lower your blood pressure. Visit www.FranciscanWeightLoss.org. • Obstructive Sleep Apnea (OSA) A condition in which people unknowingly stop breathing several times a night, OSA is a risk factor for atrial fibrillation, or arrhythmia. Treating OSA appears to reduce recurrence of arrhythmia—and in turn helps prevent heart failure or stroke. Visit www.FHShealth/sleep. For more information about conditions that can affect your heart health, visit our award-winning health library at www.FHShealth.org/healthinfo.

For help finding a Franciscan primary care or specialty physician or professional provider, visit www.FranciscanDoctors.org or call our free physician referral service at 1 (888) 825-3227. Se habla español.

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Free blood pressure checks

Our Franciscan Family Offers Yours All the Help You Need for a Heart-Healthy Life.

Monitor your blood pressure between doctor visits at our Heart Check Center™ kiosks located at area shopping malls: • Commons Mall, Federal Way • Tacoma Mall, Tacoma • South Hill Mall, Puyallup

Support Groups Ready to quit? Freedom from Tobacco Support Group St. Joseph Medical Center, Tacoma, Dining Room 1 on Thursdays, 7 p.m. Free, no registration required; just come! Call for more information: (253) 426-6746.

Want to lose weight? Franciscan Center for Weight Management • Weight Loss Surgery Full range of surgical options, including gastric bypass and adjustable gastric bands, helping patients reduce and manage their weight for life and lower the risk of chronic health problems. • Back On Track For those who have had bariatric surgery and gained weight. Goal setting, nutritional education and group activities help you get “Back on Track.” Learn more about our ASMBS Bariatric Surgery Center of Excellence at St. Francis hospital: FranciscanWeightLoss.org

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Take nutrition up a notch! • Franciscan Outpatient Nutrition Education Center Individual nutrition counseling, body composition analysis and more. Call (253) 426-4926. • Healthy Heart Nutrition Series Covers types of fat, label reading, recipe substitutions, strategies for dining out and more. Call 1 (888) 825-3227.

Dealing with diabetes? Certified educators help you manage diabetes and live well. Call (253) 426-6753 or visit www.FHShealth.org.

• WomenHeart of Pierce County WomenHeart is run by heart event survivors. The group is open to women with any type

of heart disease and supports their spiritual, emotional and educational needs. Visit www.womenheart.org or contact Tina Blackett at TinaBlackett@FHShealth.org, (253) 426-4456. • A.W.A.K.E. Support Group The “Alert Wakefulness and Keeping Energetic” (A.W.A.K.E.) supports Continuous Positive Airway Pressure (CPAP) wearers and their families, and covers topics related to obstructive sleep apnea. For more information, call (253) 985-6951.

Know your health risk — three simple steps to save your life 1. Learn Your Health Risk Take a free, confidential, online health risk assessment.

VascularAware Leg pain? Maybe your muscles are oxygen hungry.

2. Listen to Your Health Risk If eligible, attend the free clinical screening where you’ll hear what steps you need to take to improve your health.

SleepAware Tired all the time? Find out why!

3. Live and Manage Health Risks Follow the clinical recommen­ da­tions and visit your doctor for a longer, healthier life!

CancerAware - Lung Lung cancer is not just for smokers. What’s your risk?

HeartAware Half who die of heart attack had no warning — or did they?

CancerAware - Breast One in eight women will get it — what’s your risk?

DiabetesAware Early detection can lower your risk of complications from diabetes. BladderAware Afraid to laugh, cough or sneeze? There is help!

FREE Franciscan Health eNews

StrokeAware Know and reduce your risk of the #1 disabling disease in America.

You tailor topics to your health needs and interests. Subscribe today at www.FHShealth.org/eNews.

Take our free, online health risk assessments at www.KnowMyHealthRisk.org.

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Franciscan Heart Center. It’s Everywhere You Find Franciscan. CARDIOLOGISTS

Daniel Wuthrich, MD

VASCULAR SURGEONS

Franciscan Heart & Vascular Associates

Ming Zhang, MD

Franciscan Vascular Associates

Tacoma (253) 627-1244 William Bilnoski, MD, FACC

Kevin Zhou, MD Sandra Hughes, ARNP Federal Way only

Tacoma (253) 382-8540 Lab service on site Todd Kihara, MD

Raed Fahmy, MD, FACC

Gig Harbor (253) 627-1244

Ramandeep Sidhu, MD

Tacoma (253)-272-7777 Nyen Chong, MD, FACS

Amrit Guptan, MD, FACC

William Bilnoski, MD, FACC

Jennifer Barnett, ARNP

Craig Hampton, MD, FACS

Timothy Larson, MD, FACC

Raed Fahmy, MD, FACC

Pamela Charboneau, ARNP

Susan Hecker, MD, MPH

Theodore Lau, MD, FACC

Timothy Larson, MD, FACC

Rosemary Peterson, MD, FACC

Theodore Lau, MD, FACC

R. Antonio Secaira, MD

Lakewood (253) 627-1244 Timothy Larson, MD, FACC

Federal Way (253) 833-8032 Lab service on site John Diaconou, MD

Patti Aramburu, ARNP Ashley Kauzlaric, ARNP Michelle Williams, ARNP Auburn & Federal Way (253) 939-1230 Venkatesh Kandallu, MD Robert Middleton, MD Patrick Reagan MD, FACC Federal Way only

Omar Dorzi, MD

R. Antonio Secaira, MD

Lakewood (253) 985-6160 Omar Dorzi, MD

Enumclaw Medical Center (360) 802-5760 Jeffrey Rose, MD, FACC

Gig Harbor (253) 530-2620 Lab service on site Omar Dorzi, MD

Rosemary Peterson, MD, FACC

CARDIOTHORACIC SURGEONS Franciscan Cardiothoracic Surgery Associates

G. Gilbert Johnston, MD, FACS Baiya Krishnadasan, MD, FACS John Luber, MD, FACS, FACC Federal Way (253) 944-4186 Nyen Chong, MD, FACS Gig Harbor (253) 530-2939 Nyen Chong, MD, FACS

Other Franciscan Heart Center services

Auburn (253) 833-8032 John Diaconou, MD

Cardiac Rehabilitation (253) 426-6768

Enumclaw (253) 833-8032 Lab only

Heart Failure Clinic (253) 627-1244 Heart Valve Clinic (253) 426-6700

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Franciscan Heart Center

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Franciscan Heart Center Services: Cardiology Heart, thoracic and vascular surgery Minimally invasive surgery Advanced imaging and diagnostics Interventional catheterization Heart failure clinic Cardiac rehabilitation

Seven minutes online with Franciscan HeartAware could save your life. Most people at risk for heart disease don’t know it. For half of them, their first symptom will be a heart attack. Heart disease can often be predicted – and prevented. Take the Franciscan HeartAware online evaluation today. If you are not at risk, you’ll have peace of mind. If you are at risk, you can get a FREE heart health screening appointment at Franciscan Heart Center.

Heart disease affects the whole family. For peace of mind, take our free online evaluation today.

Take your Franciscan HeartAware evaluation at  www.HealthyHeartCheck.org today.

For advanced medicine and trusted care, CHOOSE FRANCISCAN.

Franciscan Heart Center St. Joseph Medical Center 1717 S. J Street Tacoma, WA 98405


Franciscan Heart Center's Heart Health! booklet